LDL Apheresis

  • Hedyeh Shafi
  • Holli M. Mason
  • Ellen KlapperEmail author


Low-density lipoprotein (LDL) apheresis is an approved treatment for (FH) patients who are intolerant or refractory to lipid-lowering medications. The purported benefit of LDL apheresis is its ability to lower the time averaged LDL concentration. The American Society for Apheresis recommends a goal of 40–60 % reduction in time averaged (interval mean) LDL from the pre apheresis level. In this chapter we will discuss the various aspects of this treatment from methodology to outcomes.


LDL apheresis (LDLa) Familial hyperlipidemia (FH) 


  1. 1.
    Marks D, Thorogood M, Neil HA, et al. A review on the diagnosis, natural history, and treatment of familial hypercholesterolaemia. Atherosclerosis. 2003;168(1):1–14.CrossRefPubMedGoogle Scholar
  2. 2.
    Yamamoto A, Harada-Shiba M, Kawaguchi A, et al. Apheresis technology for prevention and regression of atherosclerosis. Ther Apher. 2001;5:221–5.CrossRefPubMedGoogle Scholar
  3. 3.
    Kavey RE, Allada V, Daniels SR, et al. Cardiovascular risk reduction in high-risk pediatric patients: a scientific statement from the American heart association expert panel on population and prevention science; the councils on cardiovascular disease in the young, epidemiology and prevention, nutrition, physical activity and metabolism, high blood pressure research, cardiovascular nursing, and the kidney in heart disease; and the interdisciplinary working group on quality of care and outcomes research: endorsed by the American academy of pediatrics. Circulation. 2006;114(24):2710–38.CrossRefPubMedGoogle Scholar
  4. 4.
    Schwartz J, Winters JL, Padmanabhan A, et al. Guidelines on the use of therapeutic apheresis in clinical practice—evidence-based approach from the apheresis applications committee of the American society for apheresis. J Clin Apher. 2013;28:145–284.CrossRefPubMedGoogle Scholar
  5. 5.
    Bambauer R, Bambauer C, Lehmann B, et al. LDL-Apheresis: Technical and clinical aspects. ScientificWorldJournal. 2012;2012:314283.CrossRefPubMedCentralPubMedGoogle Scholar
  6. 6.
    Schuff-Werner P, Fenger S, Kohlschein P. Role of lipid apheresis in changing times. Clin Res Cardiol Suppl. 2012;7(Suppl. 1):7–14.CrossRefPubMedCentralPubMedGoogle Scholar
  7. 7.
    Immergut, S. U.S. Food and Durg Administration. FDA Approves New Pediatric Use for Liposorber Apheresis System. U.S. Department of helth and Human Services. 10 Oct. 2013.
  8. 8.
    Parhofer KG, Geiss HC, Schwandt P. Efficacy of different low-density lipoprotein apheresis methods. Ther Aper Dial. 2001;4:382–5.Google Scholar
  9. 9.
    Thompson GR, HEART-UK LDL Apheresis Working Group. Recommendations for the use of LDL apheresis. Atherosclerosis. 2008;198:247–55.CrossRefPubMedGoogle Scholar
  10. 10.
    Zenti MG, Stefanutti C. Effects of selective HELP LDL-apheresis on plasma inflammatory markers concentration in severe dyslipidemia: implication for anti-inflammatory response. Cytokine. 2011;56:850–4.CrossRefPubMedGoogle Scholar
  11. 11.
    Bambauer R, Schiel R, Latza R. Low-density lipoprotein apheresis; an overview. Ther Apher Dial. 2003;7:382–90.CrossRefPubMedGoogle Scholar
  12. 12.
    Rogers, Roby L., MD, and Laura LW Cooling, MD. “Chapter 21”. In: Bruce C. Mcleod, editors. Apheresis: Priciples and Practice, 2nd ed. Bethesda, MD: AABB; 2010. p. 478–79.Google Scholar
  13. 13.
    Stefanutti C, D’Alessandri G, Russi G, et al. Treatment of symptomatic hyperLp(a)lipoproteinemia with LDL-apheresis: a multicentre study. Atheroscler Suppl. 2009;10(5):89–94.CrossRefPubMedGoogle Scholar
  14. 14.
    Thompson GR, Lowenthal R, Myant R. Plasma exchange in the management of homozygous familial hypercholesterolaemia. Lancet. 1975;1:1208–11.CrossRefPubMedGoogle Scholar
  15. 15.
    Thompson GR, Myant NB, Kilpatrick D, et al. Assessment of long-term plasma exchange for familial hypercholesterolaemia. Br Heart J. 1980;43:680–8.CrossRefPubMedCentralPubMedGoogle Scholar
  16. 16.
    Thompson GR, Miller JP, Breslow JL. Improved survival of patients with homozygous familial hypercholesterolaemia treated by plasma exchange. Br Med J. 1985;291:1671–3.CrossRefGoogle Scholar
  17. 17.
    Eisenhauer T, Armstrong VW, Wieland H, et al. Selective removal of low density lipoprotein (LDL) precipitation at low pH: first clinical application of HELP system. Klin Wochenschr. 1987;65:161–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Mabuchi H, Michishita I, Takeda M, et al. A new low density lipoprotein apheresis system using two dextran sulfate cellulose columns in an automated column regenerating unit (LDL continuous apheresis). Atherosclerosis. 1989;68:19–25.CrossRefGoogle Scholar
  19. 19.
    Kolansky DM, Cuchel M, Clark BJ, et al. Longitudinal evaluation and assessment of cardiovascular disease in patients with homozygous familial hypercholesterolemia. Am J Cardiol. 2008;102:1438–43.CrossRefPubMedGoogle Scholar
  20. 20.
    Palcoux J-B, Atassi-Dumont M, Lefevre P, et al. Low-density lipoprotein apheresis in children with familial hypercholesterolemia: follow-up to 21 years. Ther Apher Dial. 2008;12:195–201.CrossRefPubMedGoogle Scholar
  21. 21.
    Hudgins L, Kleimann B, Scheuer A, et al. Long-term safety and efficacy of low-density lipoprotein apheresis in childhood for homozygous familial hypercholesterolemia. Am J Cardiol. 2008;102:1199–204.CrossRefPubMedGoogle Scholar
  22. 22.
    Kroon AA, van’t Hof MA, Demacker PN, et al. The rebound lipoprotein after LDL-apheresis. Kinetics and estimation of mean lipoprotein levels. Atherosclerosis. 2000;152:519–26.CrossRefPubMedGoogle Scholar
  23. 23.
    Thompson GR, Barbir M, Davies D, et al. Efficacy criteria and cholesterol targets for LDL apheresis. Atherosclerosis. 2010;208:317–21.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Transfusion MedicineCedar Sinai Medical CenterLos AngelesUSA

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